Fear of the dentist? It's all in the dreading

Dr. Larry Weeda (top right), a professor at the University of Tennessee College of Dentistry in Memphis, discusses patient Mary Walker’s symptoms with third-year student Ben McDonald (top left) during a recent clinic session. “You should be more afraid to not go to the dentist,” Weeda says.

You hear whirring and grinding, your mouth and head are vibrating, you feel as if you are hanging like a bat, a bright light stabs your eyes, part of your face is numb, and people with masks are staring into your mouth and poking it with sharp objects.

Welcome to the dentist's office, a chamber of fear for some, but a necessary step to good health for all.

"You should be more afraid to not go to the dentist," says Dr. Larry Weeda, professor and chairman of the department of oral and maxillofacial surgery at the University of Tennessee College of Dentistry in Memphis.

"Dental diseases have a systemic impact that we didn't even know about 20 years ago, and a bad tooth can put you in the hospital," he said. "Teeth don't heal themselves."

Dentophobes delay dental care for years, Weeda said, only to eventually be forced into the chair because of an accident or excruciating pain from a neglected tooth. The fear and dread probably began long before the patient had to return to a dental chair.

"It helps so much to find out what is at the root of a patient's fear and talk about it," Weeda said. "It often stems from a bad childhood experience with a dentist."

Peter Martin, a 64-year-old psychotherapist in Oxford, Miss., says his very first memory was a traumatic incident that kept him away from dental care for more than 30 years.

"I had a tooth pulled when I was 5 years old," he said. "I remember going home that night and waking up vomiting blood. It terrified me."

Martin said he went back to the dentist and had surgery to have the wound stitched up; when he and his parents met with the dentist about a week later, they were told, "Well, he's just a bleeder."

"I remember everything," he said. "The color of the walls of the office, the blood in the middle of the night, and I can still smell the ether they gave me to put me to sleep."

Martin missed dental appointments for decades after that, until one day he finally had to address some intense tooth pain.

"I told this dentist what had happened back in my childhood," he said. "He told me to put into context how long ago that was. Then he gave me nitrous oxide and I didn't have pain. But I remember that first experience like it was yesterday, and that was almost 60 years ago."

The ancient Chinese probably used acupuncture, but tooth extractions in Western culture were once done by barbers with pliers (thus the red and white stripes on barber poles). Then came the concept of dental anesthesia in 1846, when Massachusetts dentist Dr. William Morton used ether on a patient. Cocaine was used as an anesthetic until the first part of the 20th century before its chemical cousin, novocaine, changed the dental world. Today's dentists have used lidocaine as their primary anesthesia for more than 50 years.

"We've come a long way with techniques and anesthetics to reduce pain," Weeda said. "There's such a variety now; we can choose from several different types of anesthetic drugs to give you some latitude."

Dr. Chris Cooley, who has a dental practice in Germantown, has been a dentist for more than 20 years and says that besides using total sedation with patients, he doesn't really think there is such as a thing as "painless" dentistry.

"Nitrous oxide is still the most popular sedation, and it does relax you," he said. "But a lot of managing a patient's pain fears has to do with the dentist's technique. The more patients a dentist has treated, the more experience a dentist has, the better he's going to be at giving injections and managing the patient's pain.

"But a lot of pain is brought on by anxiety."

Dr. Peter Milgrom, a professor of Dental Public Health Sciences and Pediatric Dentistry in the University of Washington's School of Dentistry, helped found the Seattle-based school's Dental Fears Research Clinic in 1982, and headed the clinic for more than 25 years. He has traveled extensively lecturing on the subject and maintains a private practice that specializes in dealing with dental fears and pain.

He responds quickly when asked if truly painless dentistry is possible.

"It absolutely can be possible," Milgrom said. "It's probably always going to be uncomfortable, and why wouldn't it be? You've got people with metal objects poking around in your mouth."

"If you use a drug and block the nerves, there shouldn't be any pain, right?" he said. "But it is not that simple. The nerves in your tooth are supported by other nerves and nerve activities. You have to take into account things like your mental state at the time.

"All of these things contribute to the overall experience, and people label these sensations as pain. And they're right. But you can deal with those factors."

He says that when he performs a dental procedure, he focuses mainly on the patient's comfort.

"I've done all these procedures thousands of times, so I already know how to do those," he said. "So I concentrate on the patient. I ask if the patient is OK, if they're feeling pain. I stop every few minutes to give both of us a rest or ask if the patient needs to go the bathroom.

"You'd be amazed at how many people in a dental chair really need to go to the bathroom but won't say anything about it."

Milgrom cites studies that say most American dentists use about half the anesthesia that dentists in other countries use and that they often are in a hurry (as is the patient) and don't wait long enough for a topical anesthesia to numb up the area of injection. Patients may fear needles, but needles don't have to hurt.

"Needles are so small and so sharp now, and they're never used twice, so if you give the area enough topical anesthesia and give it time to take effect, there's no reason why you should even feel that needle," he said. "When the patient can't feel the needle, then you can numb a wider area, and then you have painless dentistry. It all comes back to the anxiety. Get rid of the anxiety."

Martin and Cooley cite how helpful nitrous oxide is, and Milgrom says it does control pain as well as provide a feeling of euphoria.

"You've got all this stimuli going on when you're in the chair," he said. "So basically, you're numbing up yet another area with nitrous. It relaxes your anxiety, so it relaxes everything. The larger the area you get numb, the less likely pain."

First of all, she insists that the dentist put soft blocks in her mouth that comfortably keep her jaws open, and she also does not hesitate to use pharmaceutical assistance whether it's nitrous oxide or something stronger. She borrowed the third technique from man's best friend.

"I tell the dental assistant to keep the lead X-ray apron on me," she said. "That may sound neurotic, but it works like a pressure vest for a thunderstorm-fearing canine.

"And that's the Betty Musselwhite Trifecta for Dentophobia."

The dental experience deals with pain, either real or imagined, and Weeda, Cooley and Milgrom say the key to a making the best out of any dental experience is simple communication.

"It really comes down to communication, as do so many other things," Weeda said. "Fear and even pain can be dealt with effectively, and a little tender loving care never hurts."

But dentophobia needs to be confronted as soon as possible, says psychotherapist Martin, who counsels patients about many different types of pain on many different levels.

"It doesn't matter if the pain is real or imagined or whether it's physical, mental or dental," Martin said. "You're not taking care of a problem by avoiding it. You're just making it worse."